Awareness and coping with emotion in schizophrenia: acceptability, feasibility and case illustrations.

UNLABELLED: Although current treatments help to alleviate some of the symptoms of schizophrenia, people with schizophrenia often continue to experience residual symptoms. An emotion-focused treatment approach may help to improve well-being in this population by increasing positive experiences and resources. In this article, we discuss the feasibility and acceptability of a skills-based group treatment for people schizophrenia or schizoaffective disorder. As part of the Awareness and Coping with Emotion in Schizophrenia (ACES) intervention, group members learned eight empirically supported cognitive and behavioural skills covering emotional awareness and coping. Group member feedback and three case illustrations illuminate participants' experiences with the group, as well as the potential benefits and challenges of this treatment approach. These data suggest that ACES is a feasible and acceptable group intervention. Future research is needed to examine whether ACES has a selective impact on well-being, but these initial findings point to the promise of this intervention to improve quality of life for individuals with schizophrenia and schizoaffective disorder, thus filling a void in existing treatments options. KEY PRACTITIONER MESSAGE: There is a void in existing treatments for schizophrenia with few interventions focusing on increasing well-being in this population. Awareness and Coping with Emotion in Schizophrenia (ACES) is a skills-based group intervention that teaches cognitive and behavioural interventions to promote awareness and coping with emotion. Preliminary evidence demonstrates the feasibility and acceptance of the ACES group intervention in increasing well-being in those with schizophrenia. Future studies should extend this work by systematically evaluating the efficacy of this treatment approach.

A retrospective study of heterogeneity in neurocognitive profiles associated with traumatic brain injury.

PRIMARY OBJECTIVE: To establish empirical sub-types, based upon cognitive test results of individuals who had sustained traumatic brain injury. RESEARCH DESIGN: The study was retrospective, applying cluster analyses and associated statistical tests to an established database. METHODS AND PROCEDURES: Neuropsychological data from veterans with brain trauma were cluster analysed using the WAIS-R and Halstead-Reitan Battery (HRB). External validity of the cluster solutions was evaluated. EXPERIMENTAL INTERVENTIONS: The study was based upon use of an established database that contained cognitive test data and information regarding diagnosis and clinical history. MAIN OUTCOMES AND RESULTS: The WAIS-R clusters described sub-groups with near normal function, preserved verbal but impaired problem-solving abilities or global impairment. The HRB clusters differed in level of performance with Near Normal, Moderately Impaired and Globally Impaired clusters. Cluster membership was associated with age and employment status, but not with neurological findings. CONCLUSION: The outcome of traumatic brain injury is heterogeneous and mainly associated with demographic considerations.

The effects of alcoholism comorbidity on neurocognitive function following traumatic brain injury.

Alcoholism and traumatic brain injury (TBI) often produce neuropsychological deficits. However, the extent and manner by which these factors interact is unclear. In this study, it was hypothesized that alcoholism would have compounding cognitive effects in individuals with TBI and alcoholism. Participants were divided into three groups, including a patient comparison (PC) group and groups with TBI with or without alcoholism histories. Participants were administered the Wechsler Adult Intelligence Scale-Revised and major components of the Halstead-Reitan Neuropsychological Test Battery. Comparing the groups on test performance, the TBI groups performed significantly worse than the PC group but did not significantly differ from each other. Thus, the effects of TBI on cognitive function overshadow preexisting deficits from the alcoholism.

The power to resist: the relationship between power, stigma, and negative symptoms in schizophrenia.

Stigmatizing beliefs about mental illness can be a daily struggle for people with schizophrenia. While investigations into the impact of internalizing stigma on negative symptoms have yielded mixed results, resistance to stigmatizing beliefs has received little attention. In this study, we examined the linkage between internalized stigma, stigma resistance, negative symptoms, and social power, or perceived ability to influence others during social interactions among people with schizophrenia. Further, we sought to determine whether resistance to stigma would be bolstered by social power, with greater power in relationships with other possibly buffering against motivation/pleasure negative symptoms. Fifty-one people with schizophrenia or schizoaffective disorder completed measures of social power, internalized stigma, and stigma resistance. Negative symptoms were assessed using the Clinical Assessment Interview for Negative Symptoms (CAINS). Greater social power was associated with less internalized stigma and negative symptoms as well as more stigma resistance. Further, the relationship between social power and negative symptoms was partially mediated by stigma resistance. These findings provide evidence for the role of stigma resistance as a viable target for psychosocial interventions aimed at improving motivation and social power in people with schizophrenia.

Psychosocial treatments for negative symptoms in schizophrenia: current practices and future directions.

Schizophrenia can be a chronic and debilitating psychiatric disorder. Though advancements have been made in the psychosocial treatment of some symptoms of schizophrenia, people with schizophrenia often continue to experience some level of symptoms, particularly negative symptoms, throughout their lives. Because negative symptoms are associated with poor functioning and quality of life, the treatment of negative symptoms is a high priority for intervention development. However, current psychosocial treatments primarily focus on the reduction of positive symptoms with comparatively few studies investigating the efficacy of psychosocial treatments for negative symptoms. In this article, we review and evaluate the existing literature on three categories of psychosocial treatments--cognitive behavioral therapy (CBT), social skills training (SST), and combined treatment interventions--and their impact on the negative symptoms of schizophrenia. Of the interventions reviewed, CBT and SST appear to have the most empirical support, with some evidence suggesting that CBT is associated with maintenance of negative symptom improvement beyond six months after treatment. It remains unclear if a combined treatment approach provides improvements above and beyond those associated with each individual treatment modality. Although psychosocial treatments show promise for the treatment of negative symptoms, there are many unanswered questions about how best to intervene. We conclude with a general discussion of these unanswered questions, future directions and methodological considerations, and suggestions for the further development of negative symptom interventions.

Emotion in Schizophrenia: Where Feeling Meets Thinking.

Our understanding of the nature of emotional difficulties in schizophrenia has been greatly enhanced by translational research over the past two decades. By incorporating methods and theories from affective science, researchers have been able to discover that people with schizophrenia exhibit very few outward displays of emotion but report experiencing strong feelings in the presence of emotionally evocative stimuli or events. Recent behavioral, psychophysiological, and brain imaging research has pointed to the importance of considering the time course of emotion in schizophrenia. This work has shown that people with schizophrenia have the ability to experience emotion in the moment; however, they appear to have difficulties when anticipating future pleasurable experiences, and this perhaps affects their motivation to have such experiences. While advancements in our understanding of emotional experience and expression in individuals with schizophrenia have been made, these developments have led to a new collection of research questions directed at understanding the time course of emotion in schizophrenia, including the role of memory and anticipation in motivated behavior, translating laboratory findings to the development of new assessment tools and new treatments targeting emotional impairments in people with this disorder.